Interoperability in Healthcare // Challenges, Innovations, and the Future

Interoperability, the ability of different systems, devices, and applications to access, exchange, interpret, and cooperatively use data in a coordinated manner, plays an essential role in the healthcare field. It contributes to improved patient care coordination, reduced healthcare costs, and a decrease in medical errors. One may even say that the future of healthcare depends on interoperability. 

Interoperability efforts in healthcare began in the 1970s, when the American Hospital Association (AHA) started to develop the Health Level Seven (HL7) standard for exchanging electronic health records (EHRs) — a standard still widely used today. Interoperability is commonly classified into three main types, each progressively involving a more sophisticated data exchange and interpretation.

Despite the advantages of digitalization over the past 40 years, the journey towards interoperability still faces significant challenges. Nonetheless, with initiatives from both the public and private sectors aiming to surmount these hurdles, the future of interoperability in healthcare looks more promising than ever before.

Understanding Interoperability in Healthcare

Interoperability in healthcare goes beyond the mere transmission of data; it ensures seamless integration and interaction among varied healthcare systems and software, promoting efficient data exchange and utilization. With its core objective to harmonize the operation of health information systems, it transcends the limitations of organizational boundaries, leading to more effective healthcare delivery, improved patient outcomes, and cost reductions.

The Office of the National Coordinator for Health IT (ONC) defines three levels of interoperability: foundational, structural, and semantic. 

• Foundational interoperability, the most basic form, enables data exchange in a basic format using common data formats such as HL7 and JSON. 
• Structural interoperability enhances foundational interoperability by standardizing the structure of data exchange. 
• Semantic interoperability, the most advanced level, ensures the meaningful use of exchanged information, emphasizing mutual data interpretation.

One notable initiative is the collaboration between Carequality and CommonWell Health Alliance.

Carequality and CommonWell Health Alliance

‍Carequality is a national-level, consensus-built, interoperability framework that enables exchange between and among health information networks. It facilitates seamless connectivity between healthcare providers, health systems, and Electronic Health Record (EHR) vendors. The framework establishes technical specifications, legal terms, use cases, and governance processes to standardize health information exchange.

CommonWell Health Alliance, on the other hand, is a not-for-profit trade association devoted to achieving cross-vendor interoperability in healthcare. It provides real-world interoperability services that enable secure access to health data across different care settings. CommonWell services include person enrollment, record location, patient identification and linking, and data query and retrieval.

In December 2016, Carequality and CommonWell Health Alliance announced a collaboration to increase health IT connectivity nationwide. This collaboration extended the reach of both initiatives, enabling broader health data exchange and breaking down data silos in healthcare. By becoming a Carequality implementer, CommonWell further expanded interoperability services for its members and service providers.

Overall State of Interoperability in Healthcare in the U.S.

Although the importance of interoperability is universally acknowledged, progress towards a fully interoperable healthcare system in the U.S. has been gradual. Data reveals an interesting discrepancy: while a high percentage of hospitals have adopted EHRs, only about half have integrated health information from sources outside their health system as of 2022. This highlights the persisting "siloed" nature of health information systems and signals a challenging journey towards achieving comprehensive interoperability.

Notwithstanding, the increasing trend of hospitals integrating health information from external sources is evident, with ONC introducing regulations and standards like the 21st Century Cures Act to further promote interoperability. Initiatives such as Carequality and CommonWell Health Alliance contribute to breaking down data barriers and fostering more integrated and coordinated care.

Despite those initiatives, the challenges to achieving comprehensive interoperability in the U.S. healthcare system persist.

The Future of Interoperability in Healthcare

Looking to the future, interoperability in healthcare holds great promise. Bolstered by relentless innovation, key stakeholder collaboration, and smart use of emerging technologies, we can foresee a healthcare system where patients have unfettered access to their health information, no matter where they receive care, without risking information security or compliance. This not only empowers patients, but also allows healthcare providers to offer more individualized and effective treatments.

Certain key trends are likely to shape interoperability in healthcare:

• The continued adoption of electronic health records (EHRs), which are central to achieving interoperability, as they serve as a centralized repository for patient data.
• The creation of new standards and technologies, such as FHIR and blockchain, that simplify health data exchange.
• The expansion of cloud computing, which facilitates data sharing and collaboration among healthcare organizations.
• The growing emphasis on patient engagement, as patients are taking a more active role in their own care and demanding access to their health information.

As these trends evolve, interoperability will likely become increasingly vital in healthcare. Successful implementation of interoperability can enhance patient care, lower costs, and mitigate medical errors.

The Role of Patients and the Benefits for Patient-Centric Care

As the ultimate beneficiaries of healthcare services, patients play a pivotal role in the march towards interoperability. The rising demand for access to their health data, along with their increasing awareness of interoperability's benefits, is placing substantial pressure on healthcare organizations to improve data accessibility.

Interoperability offers numerous benefits to patients. Fundamentally, it ensures patients can access their complete health information wherever they receive care. This can help decrease medication errors and aid patients in better understanding their health status and making informed decisions about their care. By promoting patient engagement and shared decision-making, interoperability can cultivate an improved patient experience and superior health outcomes.

Interoperability brings specific benefits to both healthcare providers and patients, including:

• Reduced risk of medication errors: Access to complete health information, including medication history, can help prevent medication errors. Healthcare providers will be aware of all the medications a patient is taking and can avoid prescribing those that might negatively interact.
• Improved understanding of health status: With access to more information, patients can better understand their health status, make informed care decisions, and more effectively participate in their own care.
• Improved patient experience: Access to a comprehensive medical record can make patients feel more in control of their care, leading to a better patient experience as they gain confidence in their healthcare providers and their ability to manage their health.
• Better health outcomes: By staying better informed patients are more likely to comply with their treatment plans, achieve their health goals and stay engaged leading to better medical outcomes and higher satisfaction.

Achieving Interoperability by Solving The Challenges

Achieving interoperability in healthcare is a not trivial task that presents complex challenges that include:

• Lack of standardized data formats and terminologies: Without a universally accepted health data exchange standard, it can be hard for different systems to communicate.
• Vendor lock-in: Dependence on a single EHR system vendor can make switching to another system difficult and costly, restricting organizations' ability to exchange data with other systems.
• Security and privacy concerns: The exchange of health data between different systems raises concerns about data security and patient privacy that must be addressed to ensure patient data protection.
• Complex state and federal regulatory landscape: Navigating the intricate web of state and federal healthcare regulations can be challenging for healthcare organizations, potentially leading to compliance errors.

As healthcare organizations face these complex challenges, the role of digital transformation becomes more critical than ever. Tech-Azur, specializes in Digital Transformation Services, in alignment with these needs, provides guidance and implements solutions tailored to these unique obstacles. Tech-Azur's approach to Digital Transformation bridges gaps between disparate systems by leveraging the following strategies:

• Adoption of Standards: Assists in integrating interoperability standards like HL7, FHIR, and CDA.
• Stakeholder Collaboration: Facilitates partnerships among healthcare providers, IT vendors, and policymakers.
• Middleware Utilization: Uses interoperability platforms and middleware technologies to bridge data gaps between disparate IT systems.
• Technology Innovation: Employs cutting-edge technologies such as cloud computing, AI, and blockchain to drive interoperability.
• Vendor Flexibility: Guides clients to manage vendor relations and advocates for the adoption of open-source or standards-compliant systems.
• Security Measures: Provides solutions for security and privacy challenges, ensuring rigorous cybersecurity measures and data privacy practices are followed.
• Regulatory Management: Keeps up to date with regulatory changes in healthcare data exchange and assists with compliance.
• Patient Engagement: Supports initiatives that empower patients with access to and control over their health data.

Furthermore, Tech-Azur’s proprietary Health Suite enables interoperability across the existing solutions while simplifying clinical and administrative processes, prioritizing patient care, operational efficiency, and regulatory compliance. 

Looking to leverage interoperability for your organization? Contact us to explore the potential it can deliver.